Smith L M, Cox R S, Donaldson S S
Department of Radiation Oncology, Stanford University Medical Center, California 94305.
Clin Orthop Relat Res. 1992 Jan(274):275-81.
Previous reports suggest an increased risk of a second cancer, primarily osteosarcoma, in survivors of Ewing's sarcoma. In a retrospective review of 25 long-term irradiated survivors of Ewing's sarcoma, the incidence of second cancers was determined. The patients were free of disease for more than three years (except for one patient who developed a second cancer 2.5 years after diagnosis), with a median follow-up period of 7.6 years. All received megavoltage radiation to the primary tumor. Twenty-four of the 25 patients were treated with chemotherapy. Second cancers developed in two patients. Acute myelogenous leukemia (AML) developed in a seven-year-old 15 months after treatment. An osteosarcoma developed within an irradiated field in a 13-year-old three years after treatment. The actuarial risk of developing a second cancer at five years is 8% whereas the actuarial risk of developing a bone sarcoma is 4%. Genetic factors may play a role in the development of AML in patients with Ewing's sarcoma. Megavoltage radiation, particularly doses greater than 60 Gy, as well as alkylating agent chemotherapy may contribute to the risk for bone sarcoma. The risk of a second cancer after successful treatment of Ewing's sarcoma is similar to that expected for survivors of all childhood cancers.
先前的报告表明，尤因肉瘤幸存者患第二种癌症（主要是骨肉瘤）的风险增加。在一项对25名接受长期放疗的尤因肉瘤幸存者的回顾性研究中，确定了第二种癌症的发病率。这些患者无病生存期超过三年（除一名患者在诊断后2.5年发生第二种癌症外），中位随访期为7.6年。所有患者均接受了针对原发肿瘤的兆伏级放疗。25名患者中有24名接受了化疗。两名患者发生了第二种癌症。一名7岁患者在治疗后15个月发生了急性髓系白血病（AML）。一名13岁患者在治疗后三年在放疗区域内发生了骨肉瘤。五年时发生第二种癌症的精算风险为8%，而发生骨肉瘤的精算风险为4%。遗传因素可能在尤因肉瘤患者AML的发生中起作用。兆伏级放疗，尤其是剂量大于60 Gy的放疗，以及烷化剂化疗可能会增加骨肉瘤的风险。尤因肉瘤成功治疗后发生第二种癌症的风险与所有儿童癌症幸存者预期的风险相似。
